Provider Demographics
NPI:1427590090
Name:WELLS, JENNIFER LEE (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 RIDENOUR BLVD NW APT 8108
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4570
Mailing Address - Country:US
Mailing Address - Phone:678-755-0062
Mailing Address - Fax:
Practice Address - Street 1:1425 RIDENOUR BLVD NW APT 8108
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4570
Practice Address - Country:US
Practice Address - Phone:678-755-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-13
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008961101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional